P1548: CMVR AND BSI ALONE AREN’T POOR PROGNOSIS RISK FACTORS IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION, BUT THEIR COMBINATION IS
Authors: Jinhua Ren, Shaozhen Chen, Jingjing Xu, Dabin Chen, Jianda Hu, Ting Yang
Journal: HemaSphere (2023)

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: In allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients, infections are a leading cause of death, particularly cytomegalovirus reactivation (CMVr) and bloodstream infection (BSI). Aims: This study aimed to evaluate the incidence of CMVr with BSI, identify risk factors, assess its impact on survival, and examine their association in allo-HSCT recipients during the first 100 days post allo-HSCT. Methods: This study is a multi-center, retrospective analysis of a patient cohort with active hematological disorders who underwent allo-HSCT in Fujian Province, China, during a 9-year time frame (March 2013 to May 2022). A total of 500 patients were enrolled in this study. 75% (n=400) of patients experienced CMVr in 100 days after allo-HSCT. There were 64.8% (n=324) male and 35.2% (n=176) female, with a median age of 26 years (range 12–40). More than half of the patients were diagnosed with acute leukemia (41.6% with acute myeloid leukemia and 23% with acute lymphoblastic leukemia). And 71% (n=355) patients received HSCT from HLA-haploidentical donors, while 20.2% (n=101) patients had HLA-matched siblings, and 8.8% (n=44) patients underwent HSCT from unrelated donors. CMVr, BSI, GVHD incidence, and OS were compared among different groups. Results: The median time to CMVr was 31 days (range 24-41). CMV was cleared in 77.8% (n=311) patients within 100 days after HSCT, and the median time was 67 days (range 53-90). The duration of CMV viremia was 35 days (range 18–54).75 (18.8%) patients developed BSI within 100 days after HSCT and 56 cases with CMVr within 100 days after transplantation. The OS was similar in the CMVr group and the No CMVr group (76.8% vs. 75.9%, P=0.7640). Cox regression analysis showed that Neutrophil engraftment vs. Failure (P<0.001; HR:95%CI 25.186 (10.135 - 62.585)) and PLT engraftment vs. Failure (P<0.001; HR:95%CI 3.505 (1.990 - 6.175)), aGVHD(I-II) vs. no aGVHD (P=0.022; HR:95%CI 1.841 (1.091 - 3.107), aGVHD(III-IV) vs. no aGVHD (P<0.001; HR:95%CI 3.399 (2.221 - 5.202)) were risk factors for OS. CMVr was excluded as a risk factor for OS in the competing risk model(P>0.05). To determine the influence of BSI with CMVr on survival, CMVr patients were divided into two groups according to BSI based on the following definitions:(1) CMVr with BSI(n=56), (2) CMVr with no BSI(n=344). The 180-day OS was lower in the CMVr with BSI group than in the CMVr with no BSI group (58.9% vs. 79.6%, P=0.003 HR 95%CI 3.131(1.688-5.808))(Figure 1B.). Long-term survival was also lower in CMVr with BSI group than in the CMVr with no BSI group (58.9% vs. 78.9%, P=0.002, HR 95%CI 3.244(1.763-5.968)) (Figure 1C). Cox regression analysis showed that Neutrophil engraftment vs. Failure (P=0.025; HR:95%CI 6.268 (1.266 – 31.041)) and PLT engraftment vs. Failure (P=0.007; HR:95%CI 4.512 (2.434 – 8.365)), aGVHD(I-II) vs. no aGVHD (P=0.007; HR:95%CI 2.212 (1.244 - 3.933), aGVHD(III-IV) vs. no aGVHD (P<0.001; HR:95%CI 4.016 (2.465 – 6.542)), CMVr with BSI vs. CMVr without BSI (P=0.045; HR:95%CI 1.665 (1.011 –2.741)) were risk factors for OS. The OS hazards are summarized in Figure 1D. The multivariate analysis identified that PLT engraftment time (HR =1.007, 95% CI: 1.002–1.012, P=0.007) was an independent risk factor for BSI within 100 days after allo-HSCT. The multivariate analysis identified that PLT engraftment time (HR =1.007, 95% CI: 1.002–1.012, P=0.007) was an independent risk factor for BSI within 100 days after allo-HSCT. Summary/Conclusion: Our results show that CMVr did not increase the incidence of BSI, but combining the two infections significantly reduced the 180-day OS (P=0.003) and long-term survival (P=0.002).Keywords: Hematopoietic stem and progenitor cells, Infection, HSCT